Sleep

A number of behavioral approaches should be considered first in treating sleep disturbances in any age group. These can be summarized as maintaining appropriate ‘‘sleep hygiene.’’ Included in this concept are:

• • avoidance of caffeine, alcohol, and nicotine (all of which disrupt sleep), especially in the second half of the day
• • assessing the effects of prescription drugs on sleep and modifying these as appropriate
• • maintaining a regular bedtime and wake time throughout the week
• • avoiding daytime napping, except for a regularly scheduled, early nap, which may be beneficial for some in reducing daytime sleepiness
• • maintaining a relaxing evening routine in preparation for bedtime, which may include reading, meditation, work on a quiet hobby, and a warm bath (except for those for whom warm baths are contraindicated)
• • use of the bedroom only for sleep or sex
• • regular, moderate exercise, but not within four hours of bedtime
• • reduced fluid intake late in the day to avoid frequent awakening to urinate during the night
• • reduced noise or light in the bedroom, if these disturb sleep, or separate bedrooms if a bed partner’s snoring or movements disturb sleep
• • an extra pillow to elevate the head in order to reduce symptoms of nocturnal acid reflux

If sleep has been chronically disrupted for whatever reason, people may develop conditioned responses to the bedroom environment that preclude sleeping. Worrying about whether one will be able to sleep is itself a common cause of poor sleep. A deconditioning approach can be used to learn to associate the bedroom with sleep rather than with anxiety about sleep. An individual undergoing deconditioning is instructed to go to bed only when sleepy and to get out of bed and go to a different room if sleep does not follow within a short, fixed interval, returning to the bed only when sleepy.